The goal of this review is to briefly review the history, physical, workup, and treatment specific to acute diarrhea in the urgent care clinical setting. Acute diarrhea is limited to less than 14 days. Below is not the complete chart of a patient with diarrhea but simply specific items that must be done for diarrhea.
Diarrhea for 1-3 days should be considered viral as 73% are viral.
Diarrhea for 3-6 days should be considered bacterial as the percentage shifts from viral to bacterial.
Diarrhea for over 6 days is more likely to be parasitic and must send stool studies, as noted below.
How many days has diarrhea been present, and is the severity improving, worsening, or the same?
How many stools per day, volume of stool, and if there is a particular smell?
What is the color and consistency of stool (blood, mucus, watery, semi-solid, etc.)?
Has the patient had exposure to others with a similar illness?
Has the patient recently taken antibiotics or are they a healthcare worker?
Fever with Tmax if present, light-headedness, abdominal pain.
Cardiac disease, immunocompromise, inflammatory bowel disease, and pregnancy.
Volume status (vitals, mucus membranes, skin turgor). Complete abdominal pain.
Urinalysis can aid volume status. Chemistry panel if the volume is very depleted.
Stool studies are indicated if more than 1 week, more than 6 stools a day, severe abdominal pain, hypovolemia, bloody diarrhea, high fever, and comorbid conditions listed above.
https://www.aafp.org/pubs/afp/issues/2014/0201/p180.html (prior issue and free to access)
https://www.aafp.org/pubs/afp/issues/2022/0700/acute-diarrhea.html (most UTD but requires AAFP membership)
E-mail: dralston@peachtreemed.com
